Stikes Hang Tuah Surasalama, Indonesia
*Corresponding Author’s Email: dyasustrami@stikeshangtuah-sby.ac.id
Introduction: Diabetes mellitus is a metabolic disease most often occurs in the elderly due to decreased function of the pancreas which produce insulin function. The number of elderly patients with DM in the village of Tell subdistrict of Sidoarjo regency Sukodono ignorance alternative ways to control blood sugar levels. The purpose of this study was to analyze the influence of herbal therapy steeping Salam leaves against a decrease in blood glucose levels in the elderly. Methods:This study design pre Experiment (One- group pre-posttest design). Samples were taken using purposive sampling and obtained as many as 28 elderly Tell Rural District of Sukodono Sidoarjo. The independent variable is the herbal therapy steeping Salam leaves and the dependent variable is blood glucose levels in the elderly. Test Glucose research instruments used for the measurement of blood sugar levels. Test data analysis using Paired T-test ρ ≤ 0.05. Results:The results showed that the steeping Salam leaves for lowering blood glucose levels in elderly people with diabetes mellitus is evidenced by the results of Test Paired t-test showed ρ = 0.000 before and after the treatment groups. Conclution:Seeing the results of this study can be concluded that the steeping Salam leaves containing astringent compounds can affect insulin sensitivity thereby stimulating the parasympathetic autonomic nerve stimulation and stimulate the release of insulin from the pancreas gland. Furthermore, the public are advised to be used as an alternative way to control blood sugar levels.
Keywords: Salam Leaf Infusion; Blood Glucose Levels; Elderly; Diabetes Mellitu
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia that occurs due to abnormalities in insulin secretion, insulin action or both of these definitions according to the ADA (American Diabetes Association, 2021). In the prevention of Diabetes Mellitus, drugs are only a complement to the diet. Drugs only need to be given if the maximum dietary regulation is not effective in controlling blood sugar levels. Oral anti-diabetes medications may be useful for people who are allergic to insulin or who don't use insulin injections. While its use must be understood, so that there is a dosage match with the indications, without causing hypoglycemia. Because most oral antidiabetic drugs have unwanted side effects, experts have developed a relatively safe traditional treatment system for Diabetes Mellitus (Rahayu, Lestari & Sayuti, 2016). Traditionally, the use of vegetable materials for treatment has been carried out by people in Indonesia. One of the vegetable ingredients used is salam leaves, namely as a reduction in cholesterol, treatment of hypertension, diarrhea, and diabetes mellitus therapy (Widowati, 2018).
The World Health Organization (WHO, 2021) also predicts an increase in the number of people with Diabetes Mellitus in Indonesia from 8.4 million in 2000 to around 21.3 million in 2030. Likewise, the International Diabetes Federation (IDF) in 2020 estimates an increase in the number of people with diabetes. Diabetes mellitus from 7.0 million in 2009 to 12.0 million in 2030. "Despite differences in prevalence rates, the two reports indicate an increase in the number of people with diabetes by 2-3 times in 2030. According to the results of the Basic Health Research, show that the highest prevalence rate of diabetes mellitus was found in West Kalimantan and North Maluku (11.1% each), followed by Riau (10.4%) and NAD (8.5%). in Papua (1.7%), followed by NTT (1.8%), the highest prevalence of disturbed glucose tolerance was West Papua (21.8%), followed by West Sulawesi (17.6%) and North Sulawesi (17.3%). ), while the lowest in Jambi (4%), followed by NTT (4.9%). The highest death rate due to DM was in the 45–54-year age group in urban areas by 14.7 percent, while in rural areas it was 5.8 percent (Agency of Health Research and Development, 2018).
There are several factors behind Diabetes Mellitus, namely, a diet that has shifted from a healthy diet containing balanced nutrition to a fast food pattern with a food composition containing lots of fat, sugar, salt, and less fiber (Adi, 2007). Diabetes mellitus is caused by disturbances in regulating glucose levels in the blood and disruption in the process of transporting glucose from the blood into cells. Even though glucose levels increase, the process of burning fat and protein remains elevated, which in turn increases ketones in the blood (acetone) and metabolic waste resulting in a process of acid toxicification. All of this is caused by the insufficient production of insulin the body needs. Therefore, Diabetes Mellitus can be said to be a condition in which blood sugar levels increase due to insulin deficiency (Susilo & Wulandari, 2011). Diabetes mellitus is a degenerative disease, namely, a chronic disease associated with decreased organ function due to the aging process. The older the age, the function of the pancreas decreases and the body's insulin ability to manage blood sugar is getting weaker (Maharani, 2010). If Diabetes Mellitus is left uncontrolled or the patient is not aware of the disease, various chronic complications will arise which can be dangereous. Heart disease, impaired kidney function, blindness, leg rot which sometimes requires amputation, to impotence (Purwanto, 2013). The elderly does not know how to avoid Diabetes Mellitus and how to control blood sugar levels when they suffer from Diabetes Mellitus. The therapy used is only medical drugs that are obtained when they come to the Integrated Healthcare Center for the elderly.
The mechanism of plant materials in inhibiting the increase in blood glucose according to the research journal by Rahayu, Lestari & Sayuti (2016), namely through inhibition of the activity of enzymes that break down sucrose and carbohydrates, inhibition of glucose absorption, inhibiting antiserotonin activity thereby increasing insulin release from the pancreas. The results of previous research conducted showed that steeping salam leaves with a level of 35% was reported to have an effect on reducing blood sugar levels after loading with glucose in rabbits equivalent to the usual dose of glibenclamide and there were no side effects on kidneys and liver in herbal extract therapy salam leaves for 4 weeks, these results indicate the herbal extract is quite safe for consumption. Herbal therapy for steeping salam leaves is an alternative way to control blood sugar levels in people with diabetes mellitus. The elderly does not know the correct procedure for making salam leaf steeping and herbal therapeutic doses to reduce glucose levels in the blood. This therapy does not cause side effects in the elderly, because this herbal therapy has been proven safe, which has been proven from previous studies.
Based on this background, the researcher wanted to study the effect of herbal therapy of steeping salam leaves on reducing blood glucose levels in elderly people with Diabetes Mellitus in Suruh Village, Sukodono District, Sidoarjo Regency.
This study uses a pre-experimental design (One-group pre-posttest design) is to reveal the cause and effect by involving one group of subjects. The subject group was observed prior to intervention, then observed again after the intervention.
In this study, the elderly population with DM will be taken at the elderly Integrated Healthcare Center in Suruh village. The population is 30 elderly with DM. In the study, the sample was taken from the elderly with DM as many as 28 people at the elderly Integrated Healthcare Center in Suruh Village, Sukodono District who met the following criteria:
Inclusion criteria
Respondents are willing to be researched.
Male and female.
Elderly aged 60-74 years.
Random blood glucose level above normal (140-220 mg/dL)
Elderly who are not taking antidiabetic drugs.
Elderly who are not in a dietary arrangement.
Exclusion criteria
Respondents resigned as respondents during the research.
At the time of the research, it turned out that the respondent was sick and could not follow the research procedures.
The sampling technique used in this study is non-probability sampling with purposive sampling technique. The research took place at the Elderly Integrated Healthcare Center, Suruh Village, Sukodono District, Sidoarjo City.
In this study, the instruments used were the observation sheet and the gluchose test. The gluchose test measurement tool is a machine for measuring blood sugar electronically or digitally so that you can easily get the measurement results. Blood sugar measurement is carried out in a sitting position. Put the blood sugar chip into the machine. Insert the needle into the pen-shaped gun and adjust the depth of the needle. Use alcohol wipes to clean your fingers, use your middle finger to check blood sugar. Shoot the needle in your finger and press so that the blood comes out. Blood is touched on the strip and not dripped on the strip. Touch on the line where there is an arrow. The blood will immediately soak in until the end of the strip and beeps. Wait a moment, the results will appear a few seconds on the screen. Remove the needle from the lancing, then discard it.
In this study, there were 28 participants from Sukodono Districts Sidoarjo City
Table 1: Identification of Respondence
Identity | Indicator | Freq | % | Total |
Gender | Male | 6 | 21% | 28 |
Female | 22 | 79% | (100%) | |
Age | 60-65 | 22 | 78,6% | 28 |
66-71 | 6 | 21,4% | (100%) | |
>71 | 0 | 0% | ||
Education | No school | 2 | 7% | 28 |
Primary | 22 | 79% | (100%) | |
Yunior | 2 | 7% | ||
Senior | 2 | 7% | ||
Job | Housewife | 17 | 61% | 28 |
farm workers | 6 | 21% | (100%) | |
Farmer | 3 | 11% | ||
Etc | 2 | 7% | ||
Income | reguler income | 3 | 11% | 28 |
irregular income | 25 | 89% | (100%) | |
DM age | 30-45 | 2 | 7% | 28 |
46-65 | 25 | 89% | (100%) | |
> 65 | 1 | 4% | ||
Resources | Midwife | 19 | 68% | 28 |
Docter | 5 | 18% | (100%) | |
Etc | 4 | 14% | ||
Control | Routine | 16 | 57% | 28 |
not a routine | 12 | 43% | (100%) | |
Family history | Yes | 7 | 25% | 28 |
No | 21 | 75% | (100%) | |
Dietary habit | Good | 28 | 100% | 28 |
Not good | 0 | 0% | (100%) |
Table 2: Blood Glucose Level Pre-Intervention
Blood glucose level | Freq | % | Control of Blood Glucose |
90-144 mg/dL | 3 | 10,7% | Good |
145-179 mg/dL | 8 | 28,6% | Moderate |
≥ 180 mg/dL | 17 | 60,7% | Bad |
Total | 28 | 100% | |
rate | 183,2 mg/dL | ||
Table 3: Blood Glucose Level Post Intervention
Blood Glucose Level | Freq | % | Control of Blood Glucose |
90-144 mg/dL | 10 | 35,7 | good |
145-179 mg/dL | 8 | 28,6 | moderate |
≥ 180 mg/dL | 10 | 35,7 | bad |
Total | 28 | 100% | |
Rate | 157,8 mg/dL | ||
Diabetes mellitus is a degenerative disease, a chronic disease associated with decreased organ function due to the aging process. The older the age, the function of the pancreas decreases and the body's insulin ability to manage blood sugar is getting weaker. There are several factors behind Diabetes Mellitus, such as a diet especially healthy diet containing balanced nutrition to a fast food pattern with a food composition containing lots of fat, sugar, salt, and less fiber.
The inability of the elderly to control blood sugar is evidenced by the result of high blood glucose levels, this is caused by physical activity carried out by the elderly. Many elderly people do not have time to go out in the morning because they are too busy cooking every morning. One of the factors causing the increase in blood sugar levels in the elderly according to Suharmiati & Roosihermiatie (2012), is a change in body composition, decreased physical activity, and changes in lifestyle. Susilo & Wulandari (2011) concluded that the accumulation of daily physical activity is the main factor determining insulin sensitivity. Weakness in the elderly also causes feeling lazy to move, especially just to do sports, which is considered something that is not usually done in the village. States that time spent idling, time spent on light activity, and moderate or strenuous activity does not affect insulin sensitivity if adjusted for total activity.
Diet is also a factor in controlling blood sugar, most respondents do not maintain their diet and they will only maintain their diet when they are sick. This means that the awareness of the elderly is still lacking in efforts to maintain a diet to control their blood sugar levels. Lack of awareness can be caused due to a lack of knowledge about the disease, so that researchers provide counseling about Diabetes Mellitus. Widowati (2018) states that the emergence of Diabetes Mellitus is not only due to heredity, but also more often due to factors. This risky lifestyle causes a high chance of disease, one of which is Diabetes Mellitus.
Other data that supports the results of the research of respondents who are in the good category in controlling blood glucose levels are supported by the results of cross tabulation between blood glucose levels before the intervention by maintaining a diet as many as 3 people have blood sugar levels of 90-140 mg / dL. A lifestyle that has begun to shift from a traditional diet that contains lots of fiber from vegetables and carbohydrates, to a westernized diet. The composition of foods that contain too much protein, fat, sugar, salt, and contain little fiber (Matheka & Alkizim, 2012).
Various work histories of the elderly are one of the influencing factors, for example, in the village farm workers usually get wages in the form of food, so that the elderly does not care about the intake of food consumed. Elderly with diabetes mellitus need special attention, especially on blood sugar levels which can increase and decrease without the sufferer knowing (Rochmah, 2006).
Various work histories of the elderly are one of the influencing factors, for example, in the village farm workers usually get wages in the form of food, so that the elderly does not care about the intake of food consumed. Elderly with diabetes mellitus need special attention, especially on blood sugar levels which can increase and decrease without the sufferer knowing (Rochmah, 2006).
The results of the analysis of the Paired T-test statistical test in the treatment group found that the provision of salam leaf steeping water had an effective effect in reducing glucose levels in the elderly suffering from diabetes mellitus, as indicated by the results of ρ = 0.000 ≤ α = 0.05. This means that if the provision of salam leaf steeping water has an effective effect, it is hoped that the elderly with diabetes mellitus can control their blood sugar levels properly through herbal therapy of steeping salam leaf water.
Antidiabetic herbal medicine can decrease blood glucose levels of diabetes mellitus patients (Rahayu, Lestari, & Sayuti, 2016). Complementary and alternative medicine with glucose-lowering effect is increasingly being sought by patients and health care professionals, therefore essential for safe anda effective control of blood glucose level (Matheka & Alkizim, 2012)
The blood glucose level of the elderly who suffered from Diabetes Mellitus before being given the intervention was 183.2 mg / dL.
The blood glucose level of the elderly suffering from Diabetes Mellitus after being given the intervention was an average of 157.8 mg / dL.
The results showed that there was an effect of herbal therapy of steeping salam leaves on reducing blood glucose levels in elderly people with Diabetes Mellitus in Suruh Village, Sukodono District, Sidoarjo Regency.
The authors declare that the research review was conducted in the absence of any commercial or economic associations that could be construed as a potential conflict of interest.
Authors would like to thank the research, development and community service institutions of Stikes Hang Tuah Surabaya which have provided financial support for the implementation of this research. We also express our gratitude to the chairman of STIKES Hang Tuah Surabaya, who has provided the opportunity to develop knowledge through research.
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